Regular Article CLINICAL TRIALS AND OBSERVATIONS Clinical disease due to enterovirus D68 in adult hematologic malignancy patients and hematopoietic cell transplant recipients

• Enterovirus D68 can infect adult patients with hematologic malignancy and HCT recipients and lead to severe respiratory disease. • Current diagnostic assays for enterovirus D68 are limited, and further studies on improved rapid diagnostic tools are needed. TheUnitedStatesCenters forDiseaseControl andPrevention reportedover 1000casesof severe respiratory disease in pediatric patients associatedwith enterovirusD68 (EV-D68) in the fall of 2014.Wesought to identifyanddefine theclinicalburdenofdiseasedue toEVD68 in adult patients with hematologic malignancy or undergoing hematopoietic cell transplant (HCT). Real-time reverse-transcriptase polymerase chain reaction (PCR) for EV-D68was performed on all respiratory samples positive for human rhinovirus (HRV) or negative for all respiratory viruses by a laboratory-developed respiratory viral PCR panel fromAugust 11, 2014, toNovember7, 2014.Presumptive casesweredefinedas thosewith an EV-D68 PCR cycle threshold (CT) at least 4 cycles lower than the HRV CT for HRVpositive samples or any EV-D68 CT value for HRV-negative samples. Sequencing of a 150-bp fragment of the 59 noncoding region confirmed EV-D68 in 16 of 506 respiratory samples. Eight patients had a history of hematologic malignancy, and 6 of these had undergone HCT. Presentation ranged from mild upper respiratory symptoms to respiratory failure. EV-D68 can infect adult patients with hematologic malignancy and HCT recipients andmaybe associatedwith severe respiratory disease. Current commercial diagnostic assays cannot differentiateEV-D68 from other enteroviruses or HRV, and improved rapid diagnostic tools are needed. (Blood. 2015;125(11):1724-1729)